Looking to the Past: Making Sense of Complexity in Military Healthcare

Written by Christopher Plein, Ph.D. West Virginia University and MFLN Caregiving Team

As a university professor, one of my main responsibilities is to teach courses on healthcare policy and administration. An underlying theme in most of my lessons is that what we think of as new or novel questions or issues are likely not so. Instead, it is most often the case that similar issues or comparable challenges have been faced in the past. As the old saying goes, “there is nothing new under the Sun.” This rang startling true to me when I recently read an article entitled “Medical Care of Naval Families.” Published in the October 1938 issue of the U.S. Naval Institute Proceedings – a journal dedicated to wide array of issues in the service that continues to be published – I was struck by similarities between now and then.

Written by Captain William Cottle, the article identifies issues relevant 80 years ago that still resonate today. One deals with the transient nature of military family life. Cottle notes that “Navy families move from one community to another. They lose contact with the old family physician or the physician in the home town” (p. 1431). He explains that the Navy’s emerging practice of providing medical services to families helps to alleviate this challenge. Yet, resources are scarce and stretched thin. He notes, “A few, very few, doctors, nurses, and hospital corpsmen have been drawn from duty with active naval personnel to meet the demand. The demand has already outstripped the capacity of assigned personnel.” For him, the solution involves help from Congress and constructive criticism, tolerance and patience from all of those involved as the system evolves. In short, “The time has come to give this service the recognition it deserves and the backing it needs” (p. 1434). Sounds familiar doesn’t it?

Cottle makes broader observations about healthcare delivery in the 1930s that are worth considering today. He notes, that “Today the number of physicians whose individual knowledge and ability is sufficient to permit them to practice successfully alone is very small.” He also considers the popular idea that the patient should be “guaranteed freedom of choice” (p. 1431). For the nascent Navy medical program, the message here is the need for coordination of care across specialties and services. There is also a message to patients and their families that in an age of systemization and specialization, choice must be balanced with the needs and capacities of the delivery system. In other words, you can’t always get what you want. Again these echoes of the past are heard clearly today whether one is in the civilian or military health systems.

In a recent blog, I discussed the priorities placed on family readiness and its evolution over time. The idea is that family readiness, achieved through support programs and personnel, contributes to force readiness. I should not have been surprised when I found these sentiments expressed by Cottle. Allowing for the more gender-specific times of his day, he justifies investment in family medical services by observing, “When officers and men are separated from their families by seagoing, their morale is heightened and their efficiency maintained if they know there is a reasonably adequate medical service for which their families may apply while the head of the family is at sea” (p. 1433).

Dipping into history is no idle academic exercise. It gives us practical insight on the issues that we deal with today. For example, an appreciation of the past gives us new insights on more recent studies and reports relating to the military health system (see for example, Military Compensation and Retirement Modernization Commission 2015, Defense Health Board 2017). It also gives us a greater sense of appreciation for those who have served and sacrificed for our country. It’s a fitting thing to consider on this Memorial Day weekend.

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This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Military Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368

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